Although the COVID-19 pandemic shifted many facets of life into people’s homes, including things never thought possible before, the idea of hospitals at home (HaH) is not new. Patients with cancer are sometimes treated with complex chemotherapy regimens in the inpatient setting, perhaps as part of treatment that would not seem to translate to the outpatient or home setting. Recently, researchers questioned whether administering these treatments at home was, in fact, possible. The results of this effort were discussed in a poster presented during the Oncology Nursing Society (ONS) Congress.
“The concept of HaHs successfully was piloted for the geriatric population as early as the mid-1990s. This demonstrated a positive impact on issues similar to those associated with hospital-based chemotherapy,” said Anne Delengowski, RN, MSN, AOCN, CCCTM, who presented the poster.
A group including nurses, providers, home infusion staff, and pharmacists convened in 2017 to talk about transitioning acute myeloid leukemia (AML) consolidation with high-dose cytarabine (HIDAC) to the home setting for select patients.
“The initial focus of the group was to assess feasibility of this process, necessary safety measures, patient criteria, and ensuring all steps that were done inpatient could be replicated in the outpatient area. The next step was to assign responsibility of task to each discipline,” Delengowski said. “Education of staff involved with this new process was completed, including an understanding of the side effects of HIDAC.”
At the time of the presentation, 29 HIDACs had successfully been administered in the home.
Following the success of the HIDAC program, the lymphoma group met again with the multidisciplinary group to determine whether dose-adjusted R-EPOCH could be moved outside of the hospital as well. While this posed different challenges than the HIDAC program, it was ultimately successful. This led to a process to transition high-dose methotrexate treatment to the outpatient setting; Delengowski reported that the group recently had their first patient success story with outpatient high-dose methotrexate.
The lessons learned from this endeavor, according to Delengowski: “Teamwork is critical. And as a group, think outside the box and be open to change to safely improve the quality of life for our oncology patients.”